Risk of progression from pre‐diabetes to type 2 diabetes in a large UK adult cohort

AIMS: People with pre‐diabetes are at high risk of progressing to type 2 diabetes. This progression is not well characterised by ethnicity, deprivation and age, which we describe in a large cohort of individuals with pre‐diabetes. METHODS: A retrospective cohort study with The Health Improvement Network (THIN) database was conducted. Patients aged 18 years and over and diagnosed with pre‐diabetes [HbA1c 42 mmol/mol (6.0%) to 48 mmol/mol (6.5%) were included]. Cox proportional hazards regression was used to calculate adjusted hazard rate ratios (aHR) for the risk of progression from pre‐diabetes to type 2 diabetes for each of the exposure categories [ethnicity, deprivation (Townsend), age and body mass index (BMI)] separately. RESULTS: Of the baseline population with pre‐diabetes (n = 397,853), South Asian (aHR 1.31; 95% CI 1.26–1.37) or Mixed‐Race individuals (aHR 1.22; 95% CI 1.11–1.33) had an increased risk of progression to type 2 diabetes compared with those of white European ethnicity. Likewise, deprivation (aHR 1.17; 95% CI 1.14–1.20; most vs. least deprived) was associated with an increased risk of progression. Both younger (aHR 0.63; 95% CI 0.58–0.69; 18 to <30 years) and older individuals (aHR 0.85; 95% CI 0.84–0.87; ≥65 years) had a slower risk of progression from pre‐diabetes to type 2 diabetes, than middle‐aged (40 to <65 years) individuals. CONCLUSIONS: South Asian or Mixed‐Race individuals and people with social deprivation had an increased risk of progression from pre‐diabetes to type 2 diabetes. Clinicians need to recognise the differing risk across their patient populations to implement appropriate prevention strategies.